Fatigue may be prelude to serious disease

Who isn't tired now and then? Ask any doctor and they will tell you patients day-after-day complain of this common problem.

But how often is the feeling of being tired associated with bone-fide medical disease? A report in the Canadian Medical Association Journal attempts to answer this question. So what should you know about the "tired all the time" (TATT) syndrome?

For two years Dr. Henk de Vries and his colleagues in Holland studied 571 patients complaining of fatigue, exhaustion or malaise. Some 10% of patients consulting Dutch physicians complained of fatigue. Of this number 46.9% were given more than one diagnosis that could be associated with this complaint.

The diseases were quite diverse, but the main categories were muscle-skeletal problems at 19.4%, infections 18.2%, and psychological troubles 16.5%. A variety of other problems such as sleep disorder and digestive upsets made up the remainder of the diagnoses.

Researchers noted as well that fatigue was frequently associated with social problems.

Fortunately, the Dutch physicians discovered that, only a minority of these patients required treatment for cardiovascular, endocrine, blood disease or cancer. Unfortunately, in his report, de Vries admitted that for at least half of the patients it was impossible to find a medical diagnosis that explained their fatigue.

The Dutch study is not the first to report the extent of fatigue. For instance, several years ago British researchers found that one in 12 people visiting the family doctor suffered from fatigue. In the U.S. it's reported that one in six patients complains of this symptom.

I'm not aware of any Canadian study dealing with fatigue, but certainly this complaint is a universal one.

Today, I'm seeing more and more patients who complain of TATT syndrome. A sizeable amount of this fatigue appears to be related to the poor state of the economy, the uncertainty of knowing whether their job may end tomorrow, or resulting family stress. But whatever the cause, constant worry takes a huge amount of energy and leaves little for every day activities.

The great problem facing doctors is to know when fatigue requires more than a sympathetic ear. Sometimes the diagnosis is apparent when a blood study shows the patient has diabetes or is suffering from chronic anemia. Or if a partner has suddenly run off with their best friend. Or a loving dog has died.

But a red flag should be raised if someone who has always been full of life and energy suddenly develops fatigue. This is when doctors make every effort to determine if an underlying disease is present.

Today the most difficult problem for physicians is dealing with patients who have had every test in the book, yet studies have failed to pinpoint a problem, and they continue to complain bitterly of the TATT syndrome.

It's always a dilemma for a doctor to have to say, "I don't know the diagnosis."

This is not good for the own ego, as no doctor wants to be a diagnostic failure. But no specific diagnosis is also unacceptable to patients. The non-diagnosis leaves uncertainty, leaving nothing for patients to hang a hat on.

That's why I recently said to a patient, "Your diagnosis is TATT. You are TATT because of marital and social problems, and these are robbing you of the so-called tiger in the tank. Your fatigue from TATT won't improve with any medication. So you have no choice but to live with TATT until these troubles are resolved. Fortunately you do not have to worry about serious medical disease."

But I also see the occasional patient who fits the description of Frederick Lewis Allen, who remarked, "I have often been struck by the fact that the symptoms of laziness and fatigue are practically identical."

This may be an unkind remark, but today I see more people who, given the choice of bed or work, prefer bed.